Overview of CAM and its Credentialing Process Within VA Stephen Ezeji-Okoye, MD Chair, VHA CO CAM FAC Outline • • • • How did we get here? Practicing CAM within VA Final Thoughts Questions How Did We Get Here? Definitions • Complementary and Alternative Medicine – A group of medical and health care systems, practices and products not presently considered to be part of conventional medicine • Complementary medicine – Used in conjunction with conventional medicine • Alternative medicine – Used in place of conventional medicine • Integrative medicine – Combination of mainstream and CAM therapies for which there is some high quality scientific evidence How Does CAM Fit Within VA? • Is CAM part of the UBP? – VA Employee Handbook revised 6-18-98 states: “ VA Public Law 104-262 calls for VA to furnish hospital and medical services that are defined as needed VA defines needed as a need for care or service that will promote, preserve and restore health.” • VHA Vision Statement – VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient centered and evidence based CAM within VA • Use is widespread - Healthcare Analysis and Information Group (HAIG) Study on CAM Utilization in VHA 2002 – 84% of VA facilities provide some form of CAM – Most common offered modalities • Acupuncture, biofeedback, chiropractic care, guided imagery, hypnotherapy, meditation, music therapy, progressive relaxation, and stress management – Most provided by conventionally trained practitioners • • • Integrated into treatment plans Wide variation in process used to credential privilege providers Limited oversight in training, experience, certification and practice of CAM providers – Limited utilization of scientific evidence to support use of CAM or support its safety and efficacy • HAIG 2010/11 White House Commission on CAM Policy • Established March 2000 by Executive Order 13147 • Aim to ensure that potential benefits of CAM become available to all citizens • 29 Recommendations covering areas – Research • promotion of rigorous scientific study of CAM – Education • Ensure appropriate education and training of CAM and conventional practitioners • Ensure availability of quality information on CAM and training of practitioners WHCCAMP – CAM Products and Standards • Ensure consistent quality and consistency • Advertising must be truthful • Collection of data on adverse effects – Access and Delivery • Improve access to safe and effective CAM practices • National oversight of how CAM practices are used • Develop and disseminate information on optimum models of complementary and integrative care • Coverage and Reimbursement by Health Plans • Federal Agencies required to respond VA’s Response • CAM Workgroup – chartered March 2003 to examine: • Appropriateness of CAM practices and process in VHA • Suggest strategies for providing ongoing national guidance related to CAM for VHA facilities and providers – CAM appropriate if safe, efficacious and delivered by practitioners with appropriate training, certification and accreditation – Recommend VA form a Field Advisory Group to promote research, integration, education on CAM within VA VA CAM Field Advisory Committee • Commissioned September 2004 • Chartered to: – Identify, assess and recommend practices for integration into VA healthcare – Advise on the integration of CAM practices into clinical practice guidelines – Identify areas where additional research is needed to determine the safety and efficacy of CAM practitioners – Recommend standards for the credentialing and privileging CAM providers within VA CAM FAC General Principles • Safety of the practice must be ensured • Must be proof of effectiveness • VHA will establish credentialing standards – Includes education and training – State licensure vs national or international standard – All practitioners must meet standards • Care may be provided by allopathic or CAM providers • Same process for evaluating allopathic practices should be applied to CAM Practicing CAM Within VA Utilizing CAM Within VA • CAM modalities permitted within VA must be safe and effective – Evidence = USPTF equivalent rating of B or better • At least fair evidence practices improves important health outcomes and benefits outweigh harms There is a sufficient, strong and consistent evidence of positive effect – Practices without clear evidence of effectiveness may be considered if: • • • • There is some evidence of effectiveness They are known to be safe Treatment options are limited Provider believes it may offer benefit to veteran Delivering CAM • All CAM procedures require informed consent – Utilize same standard as allopathic treatments • VHA will establish credentialing standards – Includes education and training – State licensure may be used as basis for standards where it exists – Education programs must be accredited • Must be by state or agency recognized by US Secretary of Education – Certification is desired – Must be proof of minimum level of ongoing education and training Delivery cont • CAM providers must be credentialed – Primary source verification is required – Must be recorded in Vetpro – CAM scopes of practices must be reviewed by PSB or equivalent body • Approved CAM activities can be provided by VHA employees, of station contract or fee personnel – All care must be ordered by and provided by licensed personnel – VHA employees may only provide CAM if it is allowed within their occupational class • CAM care must be documented in the medical record CAM and Fee Basis • Fee basis use should follow the same rules as allopathic treatment – VA must offer a reasonable treatment for a condition – VA does not have to offer all treatments • No requirement to offer CAM – Currently no CAM modality is the best treatment for any condition – CAM may be offered on fee if there is proof of efficacy and there are believed to be benefits from this treatment over other options Final Thoughts • C&P is ultimately a local issue – Central guidance • Lack of CAM occupational classes within VA • Education – Need to establish acceptable standard • Licensure and Certification • Integration into holistic treatment plan • Treatment vs Wellness